Application of fine-needle biopsy techniques for the diagnosis of acquired toxoplasmosis

The aim of the study was to apply a detailed, multidisciplinary differential diagnosis in patients with signs of lymphadenopathy for increasing in an early detection of malignancies and infectious diseases. One hundred and fifty-two patients directed to the Clinic, with a local or systemic enlargement of lymph nodes, who were suspected of acquired toxoplasmic lymphadenitis were studied. Multidisciplinary analysis of etiological factors of lymphadenopathy based on epidemiological, clinical, imaging, immunodiagnostic and cytological investigations were performed. Cervical lymph nodes were enlarged in clinical and ultrasonographic examinations in 21.7% of analysed patients, cervical and nuchal lymph nodes were enlarged in 27.6% of patients, cervical and submandibular location was found in 25.7% of individuals, and more than 2 groups of lymph nodes were enlarged in 25.0% of patients. Co-existing non-specific symptoms were documented in 124 patients (81.6%). Potential risk factors of T. gondii infection were found in all the patients; in a majority of patients more than one source of invasion was observed. Fifty-nine patients were finally qualified for the fine-needle aspiration biopsy of enlarged lymph nodes. They demonstrated specific anti-T. gondii immunoglobulin M antibodies and elevated titres of specific IgG antibody of a low avidity in immunodiagnostic tests, or a doubtful clinical picture suggesting proliferative hematological diseases. In the cytological investigation, reactive follicular hyperplasia with irregular clusters of typical for toxoplasmosis epithelioid histiocytes was confirmed. In 5 patients lymphoma or planoepithelial cancer of mouth was early diagnosed. Patients were successfully treated with a combination of Pyrimethamine and Sulphadiazine and a cover of folinic acid and regularly controlled for peripheric blood tests parameters. Individuals with diagnosed lymphoproliferative malignancies were directed to specialized centres for specific chemotherapy.
Conclusion: multidisciplinary analysis of patients with lymphadenopathies is crucial for increasing in the early detection of lymphatic neoplasms, malignancies, or systemic and infectious diseases in cases with co-existing immunization against Toxoplasma gondii.